<div class="ui raised very padded text segment">
    <div class="ui form">
        <div class="inline fields">
            <label for="type">业务类型</label>
            <div class="ui selection dropdown">
                <input type="hidden" name="gender">
                <i class="dropdown icon"></i>
                <div class="default text">接送机</div>
                <div class="menu">
                    <div class="item" data-value="1">接送机</div>
                    <div class="item" data-value="0">接送机2</div>
                </div>
            </div>
        </div>
        <div class="inline fields">
            <label for="type">面值</label>
            <div class="field">
                <input type="text" name="supplierName" placeholder="">
            </div>
        </div>
        <div class="inline fields">
            <label for="type">数量</label>
            <div class="field">
                <input type="text" name="supplierName" placeholder="">
            </div>
        </div>
        <div class="inline fields">
            <label for="type">有效期起止时间</label>
            <div class="field dimmable">
                <div class="ui left icon input">
                    <input type="text" id="from" name="reqBeginDate" placeholder="请输入选择起始日期">
                    <i class="calendar icon"></i>
                </div>
            </div>
            <div class="field dimmable">
                <div class="ui left icon input">
                    <input type="text" id="to" name="reqEndDate" placeholder="请输入选择结束日期">
                    <i class="calendar icon"></i>
                </div>
            </div>
        </div>
        <div class="inline fields">
            <label for="type">添加原因</label>
            <div class="field">
                <input type="text" name="supplierName" placeholder="">
            </div>
        </div>
        <div class="inline fields">
            <button class="ui button" id="checkBtn" type="submit">添加</button>
        </div>
    </div>
</div>
